# Use of Proton Pump Inhibitors and Risk of Hip Fracture in Relation to Dietary and Lifestyle Factors: A Prospective Cohort Study

 Title: Use of Proton Pump Inhibitors and Risk of Hip Fracture in Relation to Dietary and Lifestyle Factors: A Prospective Cohort Study Author: Khalili, Hamed; Camargo, Carlos Arturo; Feskanich, Diane; Chan, Andrew Tan; Huang, Edward S.; Jacobson, Brian C. Note: Order does not necessarily reflect citation order of authors. Citation: Khalili, Hamed, Edward S Huang, Brian C Jacobson, Carlos A Camargo, Diane Feskanich, and Andrew T Chan. 2012. Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: A prospective cohort study. BMJ 344: e372. Full Text & Related Files: 3269660.pdf (375.2Kb; PDF) Abstract: Objective: To examine the association between chronic use of proton pump inhibitors (PPIs) and risk of hip fracture. Design Prospective cohort study. Setting: Nurses’ Health Study, which originally recruited from the 11 most populous states in the US. Participants: 79 899 postmenopausal women enrolled in the Nurses’ Health Study who provided data on the use of PPIs and other risk factors biennially since 2000 and were followed up to 1 June 2008. Main outcome measure: Incident hip fracture Results: During 565 786 person years of follow-up, we documented 893 incident hip fractures. The absolute risk of hip fracture among regular users of PPIs was 2.02 events per 1000 person years, compared with 1.51 events per 1000 person years among non-users. Compared with non-users, the risk of hip fracture among women who regularly used PPIs for at least two years was 35% higher (age adjusted hazard ratio 1.35 (95% confidence interval 1.13 to 1.62)), with longer use associated with increasing risk (P$$_{trend}$$<0.01). Adjustment for risk factors, including body mass index, physical activity, and intake of calcium did not materially alter this association (hazard ratio 1.36 (1.13 to 1.63)). These associations were also not changed after accounting for reasons for PPI use. The relation between PPI use and fracture differed by smoking history (P$$_{interaction}$$=0.03). Among current and former smokers, PPI use was associated with greater than 50% increase in risk of fracture, with a multivariate hazard ratio for fracture of 1.51 (1.20 to 1.91). In contrast, among women who never smoked there was no association (multivariate hazard ratio 1.06 (0.77 to 1.46)). In a meta-analysis of these results with 10 prior studies, the pooled odds ratio of hip fracture associated with PPI use was 1.30 (1.25 to 1.36). Conclusion: Chronic use of PPIs is associated with increased risk of hip fracture, particularly among women with a history of smoking. Published Version: doi:10.1136/bmj.e372 Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3269660/pdf/ Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:9366537